Professionalism Reborn E-Book

Eliot Freidson

• Herausgeber: John Wiley & Sons
• Kategorie: Geisteswissenschaft
• Sprache: Englisch

Seitenzahl: 478

Veröffentlichungsjahr: 2013

Beschreibung

This book is an original interpretation of the professions and the role of the professional in Western industrial societies today.

Das E-Book Professionalism Reborn wird angeboten von Polity und wurde mit folgenden Begriffen kategorisiert:
book; explores; questions; western; today; freidson; societies; broad; several; eliot; professionalism; industrial; future; policy; public; problems; interpretation; compelling; professional; professions; understood; work; control

Leseprobe

PROFESSIONALISM REBORN

Theory, Prophecy, and Policy

Eliot Freidson

Polity Press

Copyright © Eliot Freidson 1994.

The right of Eliot Freidson to be identified as author of this work has been asserted in accordance with the Copyright, Designs and Patents Act 1988.

First published in 1994 by Polity Press in association with Blackwell Publishers.

Reprinted 2004

Editorial office:Polity Press65 Bridge StreetCambridge CB2 1UR, UK

Marketing and production:Blackwell Publishers108 Cowley RoadOxford OX4 1JF, UK

All rights reserved. Except for the quotation of short passages for the purposes of criticism and review, no part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publisher.

Except in the United States of America, this book is sold subject to the condition that it shall not, by way of trade or otherwise, be lent, re-sold, hired out, or otherwise circulated without the publisher’s prior consent in any form of binding or cover other than that in which it is published and without a similar condition including this condition being imposed on the subsequent purchaser.

ISBN: 978-0-7456-6632-7 (Multi-user ebook)

British Library Cataloguing-in-Publication DataA CIP catalogue record for this book is available from the British Library.

Typeset in 10 on 12pt Garamond Stempelby Graphicraft Typesetters Ltd, Hong Kong

Printed and bound in Great Britain byMarston Book Services Limited, Oxford

This book is printed on acid-free paper.

For Molly

Contents

Acknowledgments

Introduction

PART ICLARIFYING THE ISSUES

1The Theory of Professions: State of the Art

2How Dominant are the Professions?

PART IIELEMENTS OF A THEORY OF PROFESSIONALISM

3The Division of Labor as Social Interaction

4Professions and the Occupational Principle

5Occupational Autonomy and Labor Market Shelters

PART IIIPROPHESYING THE FUTURE OF THE PROFESSIONS

6Professionalization and the Organization of Middle-Class Labor in Post-Industrial Society

7The Futures of Professionalization

8The Changing Nature of Professional Control

PART IVCHOOSING PROFESSIONALISM AS SOCIAL POLICY

9Are Professions Necessary?

10Professionalism as Model and Ideology

11The Centrality of Professionalism to Health Care

12Nourishing Professionalism

References

Index

Acknowledgments

The essays in this volume appear as originally printed, though in some cases text and references were cut to minimize repetition, and brief text added to link papers to one another. Their original substance (as well as the references they relied on at the time) has been preserved.

“The Theory of Professions: State of the Art,” appeared in Robert Dingwall and Philip Lewis (eds), The Sociology of the Professions: Lawyers, Doctors and Others (London: Macmillan, 1983), pp. 19–37. © 1983, Eliot Freidson. Reprinted by permission of The Macmillan Press Ltd.

“How Dominant are the Professions?” appeared in Frederic W. Hafferty and John B. McKinlay (eds), The Changing Medical Profession: An International Perspective (New York: Oxford University Press, 1993), pp. 54–66. © 1993 Oxford University Press. Reprinted by permission.

“The Division of Labor as Social Interaction” is reprinted from Social Problems, 23, 3 (1976), pp. 304–13, by permission. © 1975 by the Society for the Study of Social Problems.

“Professions and the Occupational Principle” is reprinted from Eliot Freidson (ed.), The Professions and Their Prospects (Beverly Hills: Sage, 1973), pp. 19–38. © 1973, Sage Publications. Reprinted by permission.

“Occupational Autonomy and Labor Market Shelters” is reprinted from Phyllis L. Steward and Muriel G. Cantor (eds), Varieties of Work (Beverly Hills: Sage, 1982), pp. 39–54. © 1982 Sage Publications. Reprinted by permission.

“Professionalization and the Organization of Middle-Class Labor in Post-Industrial Society” originally appeared in Sociological Review Monographs, no. 20 (1973), pp. 47–59. Reprinted by permission.

“The Futures of Professionalization” originally appeared in Margaret Stacey, Margaret Reid, Christian Heath, and Robert Dingwall (eds), Health and the Division of Labour (London: Croom Helm, 1977), pp. 14–38. Reprinted by permission.

“The Changing Nature of Professional Control” is reproduced from the Annual Review of Sociology, 10 (1984), pp. 1–20. © 1984 by Annual Reviews. Reprinted by permission.

“Are Professions Necessary?” originally appeared in Thomas L. Haskell (ed.), The Authority of Experts: Studies in History and Theory (Bloomington: Indiana University Press, 1984), pp. 3–27. © 1984 Indiana University Press. Reprinted by permission.

“Professionalism as Model and Ideology” is reprinted from Robert L. Nelson, David M. Trubek, and Rayman L. Solomon (eds), Lawyers’ Ideals/Lawyers’ Practices: Transformations in the American Legal System (Ithaca: Cornell University Press, 1992), pp. 215–29. Copyright © 1992 by Cornell University. Used by permission of the publisher, Cornell University Press.

“The Centrality of Professionalism to Health Care” is reprinted by permission from Jurimetrics: Journal of Law, Science and Technology, 30 (summer, 1990), pp. 431–45.

“Nourishing Professionalism” is reprinted from Edmund D. Pellegrino, Robert M. Veatch, and John P. Langan (eds), Ethics, Trust, and the Professions: Philosophical and Cultural Aspects (Washington: Georgetown University Press, 1991), pp. 193–215. Reprinted by permission.

Introduction

This book brings together a selection of the essays I have written about the professions over a period of twenty years. Both my preoccupation with the topic and my writing about it extend back even further, however, for when I undertook intensive study and analysis of the medical profession during an earlier decade, the larger problem of understanding professionalism1 as a general phenomenon was never out of my mind. But with the exception of a recent paper that argues an important policy issue for the professions in general by analyzing efforts to control the cost of American health care in particular, nothing of what I have written about medicine and health care is included here.2

The papers address a number of different topics and are arranged in several broad categories. The articles in Part I are concerned with appraising the state of the field, the reasons for some of its inadequacies, certain of the methodological issues it must face, and the complexity of the phenomenon it addresses. In Part II I advance some of my own efforts to develop a theory, beginning by establishing my choice of occupational control of work as the guiding concept for the theorizing, and then elaborating its implications. The essays in Part III turn to the more topical matter of evaluating the present position of professions in advanced industrial society in the light of recent shifts in public opinion and state policy. I analyze forecasts of professional decline in the light of available evidence, and indicate what I believe is happening to the professions today. In Part IV the tenor of the essays shifts from descriptive analysis to an attempt to inform social policy, which must inevitably judge and choose among alternatives and cannot be neutral. I argue that, on balance, professionalism is preferable to alternative modes of organizing the work of professionals (and others) and suggest how its virtues can be reinforced.

THE EARLY POSTWAR PERIOD

At any given time, much of what is chosen to write about reflects not only the stage of development of one’s own thinking but also a response to contemporary issues and interests. Thus, these essays must be seen in part as a product of the development of the field of the sociology of professions during the second half of the twentieth century. Let me briefly sketch that development in order to provide a context for them.3

As I note in Chapter 1 and other essays in this book, the professions have been considered worthy of special attention in the English-speaking world for at least a century. Herbert Spencer dwelt on their special importance in English society, as did Beatrice and Sidney Webb, R. H. Tawney, A. M. Carr-Saunders, and T. H. Marshall, each for different reasons. But the concept of profession was largely taken for granted, and there was little systematic thinking about it until academic sociology in the United States expanded after World War II. The most widely known American theorist, Talcott Parsons, had been perhaps the earliest to address the professions in theoretical terms. In a prewar essay (Parsons, 1939) he sought to make sense of the ostensible contradiction between the idea that professions manifest altruistic rather than self-interested behavior and the assumption on the part of economic theory and utilitarianism that all behavior is self-interested. In postwar work (Parsons, 1951, 1964, 1968) he theorized about both the medical and the legal professions, and claimed special importance for the professions in advanced industrial societies. In a lower key, outside the then-dominant functionalist tradition, Everett Hughes (1958) wrote a series of provocative essays that cut through the mystique with which professions attempt to surround themselves, analyzing both what they had in common with far more humble occupations, and what distinguished them.

In addition to those pre-eminent sociologists, many other well-known writers made self-conscious efforts to develop a concept of profession that would distinguish it from other occupations, and to discover regularities in the historic process by which an occupation attains professional status (e.g., Wilensky, 1964; Goode, 1969; Moore, 1970). By the 1960s,4 a number of British sociologists had joined in the enterprise (e.g., Jackson, 1970; Elliott, 1972). A literature of considerable size had begun to accumulate.

THE CRITICAL PERIOD

Until the 1960s, the tenor of writings by scholars on the professions was, by and large, neutral. If it was not critical of the professions, neither was it laudatory. Only Talcott Parsons (who was himself hardly an apologist for the professional status quo) singled them out for a position of special importance in his vision of modern society. As for other fields, however, the 1960s were an intellectual watershed for the study of the professions. Under the ideological influence of that period, historians and sociologists began producing “revisionist” histories of the professions and their institutions, emphasizing their economic self-interest and concern for their status in the policies they pursued, and analyzing how their activities facilitated control of the poor, the working class, and the deviant (e.g., Platt, 1969; Rothman, 1971; Auerbach, 1976). Influential sociological essays warned against the adoption of the professions’ own self-advertisements and, denying the possibility of neutrality, urged both a more critical stance and taking the side of the deviant and the client.

By the early 1970s, two writers reflected the intellectual ferment of the previous decade and shifted the emphasis of subsequent theorizing about the professions away from their role in holding society together and toward issues of conflict and power. My books Profession of Medicine (1988 [1970a]) and Professional Dominance (1970b) were focused on the medical profession and the organization of health care, while keeping in sight the implications of the analysis for understanding professions in general. They emphasized the ideological character of professional claims, unjustified aspects of monopolistic privilege, and the way organized professional institutions create and sustain authority over clients, associated occupations, and the very way we think about deviant or undesirable behavior. Shortly afterwards Terence Johnson (1972) defined profession as a method of controlling work – one in which an occupation, rather than individual consumers or an agent or agency mediating between occupation and consumer, exercises control over its work. And he emphasized the role of power in establishing and maintaining such control. Subsequent literature from both the United Kingdom and the United States was described by commentators as taking a “power approach” rather than the “trait approach” of earlier structural-functional writers. Later in the decade, Larson’s The Rise of Professionalism (1977) brought both Marxist and Weberian theory to the fore in her analysis of professions, studying them as interest groups linked to the class system of capitalist societies and analyzing professionalization as a “collective mobility project” in which occupations seek to improve not only their economic position but also their social standing, or prestige. The broad historical orientation of her work also stimulated greater interest in historical studies of professionalization, which I shall discuss shortly.

The revival of Marxist analysis in the United Kingdom and the United States from the 1960s on also made its mark on studies of professions. Marxism, of course, emphasized the ultimate importance of economic relations. But so, too, does economic liberalism, which was also revived. The intellectual consequence was that those otherwise mutually hostile ideologies joined in attacking the social standing and economic privilege of professions, arguing that professionalism represents unjustified elitism that reinforces the class system, and that its exclusionary “social closures” limit opportunity (Collins, 1979) and interfere with the operation of a free and putatively efficient labor market. Similar criticism was implicit in the more neutral-sounding academic work of those adopting the “power approach.” It remains the dominant theme in evaluating professionalism today, perhaps because in virtually all capitalist democracies the high cost of health, legal, education, welfare and other professional services has become a critical policy issue.

In the early 1970s, the primary target of most of the British and American writers criticizing the professions was medicine – how it dominated social policy, the other occupations in the health-care division of labor, the institutions in which its members work, and patients or consumers, and how it has “medicalized” personal and social problems (e.g., Berlant, 1975; McKinlay, 1973). But later in the decade, under the influence of Marxism, the emphasis on medicine’s power (and the power of the professions) began to shift. The literature turned to predicting the decline of medicine, law, and professions in general. A considerable literature has since grown up that speculates about the consequences for the professions of financial and administrative policies being undertaken both by private corporations and by the state. In addition, attention has focused on the possible consequences of changes within the professions themselves, such as increasing numbers of practitioners and greater internal stratification and fragmentation into specialties, not to speak also of the influence of consumer movements. All analysts agree that in virtually every industrial nation the professions are going through important changes. Marxist analysts predictably forecast proletarianization; others prophesy considerable reorganization of the professions, if not actual loss of their status.

THE EMERGING COMPARATIVE APPROACH

Until the 1980s, medicine served as the primary model for conceptualizing professionalism. An early essay by Rueschemeyer (1964) pointed out that there are major differences between law and medicine even though both are recognized by everyone as true professions, and he warned against generalizing from medicine alone. But since it was medicine and paramedical occupations that were familiar to most writers, his warning fell on deaf ears and had little influence at the time. By the 1970s, sociologists in Canada, Australia, and New Zealand had joined British and American sociologists in studying the professions – concentrating on medicine and related occupations in the English-speaking countries (e.g., Larkin, 1983; Willis, 1989), but beginning to pay some sustained attention to the legal profession (e.g., Dingwall and Lewis, 1983).

By then, however, an increasing number of historians were undertaking studies of professions that began appearing in print in the 1980s. Indeed, histories of professions became, in the words of one review-essayist (Ramsey, 1983), a cottage industry for historians. Furthermore, they did not restrict themselves to health-related professions in English-speaking nations (e.g., Geison, 1983a, 1983b; Frieden, 1981; Peterson, 1978; Gawalt, 1984; Cocks and Jarausch, 1990; Ramsey, 1988). Typically, they turned to sociology for concepts and theories to use either as a guide or as rhetorical straw men for organizing their exposition. Many of those studying professions on the continent found those concepts wanting (e.g., Gispen, 1988). But sociologists had also become dissatisfied with concepts that were developed more for analyzing medicine than other professions, and, even then, in English-speaking countries with relatively decentralized and passive governments.

Strong interest in the professions grew on the continent as well as in English-speaking countries during the 1980s. Previously, European scholars had seemed to consider the concept of profession to be of little pertinence to their own societies. This is not to say that they ignored medicine, law, and other educated, middle-class occupations, or that they were unaware of the increasingly conspicuous role of experts in their societies. But they did not use the Anglo-American concept of profession to organize the way they dealt with those topics. Their neglect of the concept was no doubt due to a number of causes, such as their intellectual propensity to think in terms of class rather than occupation, the absence of a term with similar implications in their own languages, and, perhaps most important, the fact that European professions in general are more closely bound to the state than their English-speaking counterparts.

For whatever the reason, during the 1980s French, German, Swedish, and other historians undertook studies of physicians, lawyers, engineers, secondary school teachers, and others (e.g., Burrage and Torstendahl, 1990; Torstendahl and Burrage, 1990). Stimulated primarily by the work of Larson, they sought to analyze how the modern professions emerged in Europe during the nineteenth and twentieth centuries – that is, the process of professionalization. In doing so, they were quite critical of the way the process had been conceptualized by earlier Anglo-American writers and sought to distinguish the different paths of different professions in different nations with different cultural and political traditions. In most, the state played an active role in initiating the institutionalization of some professions and reorganizing others. Furthermore, in many cases it served as the professions’ prime employer. This obviously made for a different course of professionalization than occurred in the English-speaking countries and will no doubt lead to new theories in the future.

Interest in comparative studies of the position of contemporary professions also developed during this time. Medical sociologists (Hafferty and McKinlay, 1993), sociologists of education (Clark, 1987), and scholars concerned with the bearing of public policy on the various professions (Freddi and Björkman, 1989; Jones, 1991) brought together volumes comparing the position of a number of different professions in the same nation, or comparing the position of the same profession in different nations. Abel and Lewis (1988a, 1988b) published a massive compendium of studies of lawyers in both civil and common law countries, as well as a volume of essays (1989a) exploring some of the theoretical implications of that comparative study. By now a considerable literature of comparative transnational studies has begun to accumulate, with many more likely to come well before the end of the century.

Parallel with growing interest in transnational comparative studies has been the growth of a marked emphasis on the role of the state in the affairs of the professions. No doubt this is due in part to having to explain the position of professions in nations on the European continent (and elsewhere), which had different kinds of state traditions, but it also reflects an intellectual shift in emphasis and interest that has taken place in the larger disciplines of political science and political sociology. Elements of that shift have begun to appear in the literature, as in my own exploration of the legal and other state-supported institutions that sustain professionalism in the United States (Freidson, 1986a), Rueschemeyer’s proposal (1986) to compare professions by adopting a state-centered rather than profession-centered approach, and Halliday’s invaluable appraisal (1989) of the pertinence of corporatist theory to understanding the position of professions in various nations.

THE STUDY OF PROFESSIONS IN THE FUTURE

It is far too early to tell where growing interest in comparative studies and in the state will take us. We can assume that historians’ interest in professionalization will continue if only because the study of how institutions develop over time is intrinsic to their discipline. Nor can there be any doubt that Abbott’s recent (1988) brilliant analysis of the role of jurisdictional claims and disputes in the changing fortunes of professions will force us to pay closer attention in the future to the interaction between occupations in contiguous positions in a division of labor. In both cases, the role of the state is almost certain to be explored more thoroughly than was the case in the past. My guess is that the emphasis on professional monopoly that has dominated the literature for many years is in decline, due partly to its own intrinsic limitations, and partly to a shift in intellectual interest that has little to do with the limitations of what is abandoned. Similarly, “revisionist” histories are likely to decline, and it may be that greater attention will be paid in the future to aspects of professionalization that cannot be explained easily by reference to material self-interest. Who knows? Whig history may yet return! Whatever else, I have little doubt that cross-national comparisons of particular professions will thrive, and I hope that the systematic comparison of different professions will also do so.

In addition, I hope that sociologists will answer Abel and Lewis’s call (1989b) to study the work that professions do and to make greater efforts to grapple with conceptualizing the influence of differences in the kind of knowledge and work on the process of professionalization (see Halliday, 1985; Abbott, 1988, pp. 33–58 and 177–211). And certainly more can be done to trace the influence of professional knowledge on both social policy and everyday life. One intellectual current that has already contributed to that topic, though not always in a comprehensible fashion, stems from the writings of Michel Foucault (e.g., 1975, 1979). While neither he nor his French followers appear to have examined closely the institutional forms through which those disciplines are exercised (see Freidson, 1986a), it is clear that he was in fact concerned with professionalism, for the professions are the agents which create and advance the knowledge embodied in disciplines, and their members project that knowledge into human and state affairs. By and large, the major exception being Magalí Larson (1989, 1990), the question of the influence of the knowledge and concepts of professions on human consciousness and state policy has been given too little attention by sociologists.

Finally, I might mention the most serious deficiency of the field today – namely, its lack of an adequate theoretical foundation. At present, the sociology of professions stands as a topical field, loosely affiliated with class theory by some, but essentially without any clear theoretical roots. I believe it should be grounded in a theory of occupations, for a profession is generically an occupation, and certainly not a class. What distinguishes occupations from each other is the specialized knowledge and skill required to perform different tasks in a division of labor. This is a distinctly different criterion than location in a class system or in a firm. As I note in Chapter 5, neither class theory nor organizational theory can account adequately for the self-organizing potential of occupations. What is needed to ground theorizing about professions is the development of a genuine sociology of work that deals in a systematic fashion with such topics as the nature and varieties of the specialized knowledge and skill that are embodied in work, the role of that specialized knowledge and skill in the differentiation of work into occupations, and the varied ways by which that differentiation becomes organized.

Apart from developing a theoretical foundation for a true theory of professions, it is essential to establish a guide for their empirical study. As I note in Chapter 2, the more comparative studies there are, the more likely is it that they will be incomparable if they are based on different conceptions of profession. I believe that a fixed standard is most useful for that purpose – namely, an ideal type. But an ideal type that can serve as a standard cannot merely define the substantive essence of some historic form of occupation. As European criticism of Anglo-American efforts to define profession has correctly shown, there is no single, invariant historic form. Success in creating a standard that can guide a wide variety of comparative studies can come only from an ideal type that is constructed systematically out of basic concepts of work, the ways by which it can be organized and controlled, and the institutions necessary for gaining and maintaining that organization.

PROFESSIONALISM REBORN

Having provided the historical and intellectual context for the essays in this volume by briefly reviewing the development of the field of the sociology of professions, I wish to note the way in which its title, Professionalism Reborn, is intended to draw them together. My efforts to conceptualize professionalism in these papers owes much to the work of earlier, now often criticized or ignored writers such as R. H. Tawney, T. H. Marshall, Talcott Parsons, Everett C. Hughes, and William J. Goode, Jr. I have tried to use their substantive insights and arguments in a manner intended to avoid the European charge of Anglo-American particularism. I propose professionalism as a logically distinct and theoretically significant alternative to currently received models for conceptualizing the organization and control of work. Thus, in a number of the essays of this volume much of the work of those earlier students of professions and professionalism becomes reborn to shape an analytic concept.

In other chapters I focus on the empirical forms of professionalism, addressing the fact that, in all major advanced industrial nations, the position of professionals and the nature of their practice are changing. My papers discuss others’ efforts to conceptualize those changes as evidence of the decline and future disappearance of professionalism. I argue, to the contrary, that the essential elements of professionalism are not disappearing, but rather are taking a new form. Professionalism is being reborn in a hierarchical form in which everyday practitioners become subject to the control of professional elites who continue to exercise the considerable technical, administrative, and cultural authority that professions have had in the past.

The essays in Part IV of this volume represent my considered response to the torrent of criticism to which professions in the United States have been subjected over the past two decades by both radical and free-market ideologues. My past work on the medical profession has been cited often to support both positions, but I believe that both are ill-considered, especially in light of the practical question “What are the alternatives to professionalism?” I try to redress what is now an extreme imbalance of intellectual opinion. The evaluative tradition of Tawney, Carr-Saunders, and Marshall is reborn in my argument that professionalism is both necessary and desirable for a decent society.

However, that argument, and the analysis of professionalism throughout this book, is grounded in the historic conventions that govern the labor market. Insofar as those who perform complex, discretionary work must gain their living by it, then professionalism represents the more desirable method of organizing their position in the labor market. The connection of professional work with income, however, is a constant stimulus to self-interested exploitation of the sheltered autonomy that professional institutions provide, so we may hardly consider professionalism to be the optimal solution to the problem of organizing work; it is merely the better of the three alternatives I discuss. Are there any other ways of organizing work by which the professional spirit can be reborn in a new and even more desirable form?

Bearing in mind my belief that a truly adequate theory of professions must be rooted in a generic theory of work, a conception of work is required that encompasses all forms of productive labor, not merely those that take place in the conventional labor market. Many kinds of work and workers do not appear in the official statistics of the modern state on which most sociologists rely. Close study of those unofficial forms of productive labor expands our conception of work beyond the official economy. Furthermore, it provides us with resources that can expand our conception of professionalism beyond the historical conventions with which this book is primarily concerned. When we look for productive labor outside the market, we find in fact many empirical circumstances in which skilled, creative work is performed for sustained periods of time largely without pay (see Freidson, 1986b; Stebbins, 1992, pp. 1–19). Such work is performed primarily for its own sake, for the love of it, or for the way it benefits others (see Freidson, 1990). In such circumstances we find a professionalism that is by choice or necessity stripped of the compromising institutions that assure workers a living, a professionalism expressed purely as dedication to the committed practice of a complex craft that is of value to others. To liberate it from material self-interest is the most radical way by which professionalism could be reborn.

NOTES

  1  I use the word “profession” to refer to an occupation that controls its own work, organized by a special set of institutions sustained in part by a particular ideology of expertise and service. I use the word “professionalism” to refer to that ideology and special set of institutions. These usages have evolved over time and are not clearly distinguished in all the essays in this volume.

  2  For a selection of my essays on medicine and health care, see Eliot Freidson, Medical Work in America (New Haven: Yale University Press, 1989).

  3  In what follows I try to provide a brief overview of the development of the sociology of the professions. The references I give are not exhaustive, referring either to key writers, or illustrating a body of writing that is not cited in the essays in this volume.

  4  The careful reader will note discrepancies between the publication dates of my citations, and my periodization. I assume a considerable lag between conception and publication, estimating a delay of between three and five years for an article in a scholarly journal and between eight and ten years for an academic book.

PART I

CLARIFYING THE ISSUES

1

The Theory of Professions: State of the Art1

While professions have never been among the core topics for sociological theorizing, a surprising number of the most prominent English-language sociologists, from Herbert Spencer (1914, pp. 179–324) to Talcott Parsons (1968), have paid them rather more than glancing attention. Until recently, most sociologists have been inclined to see professions as honored servants of public need, conceiving of them as occupations especially distinguished from others by their orientation to serving the needs of the public through the schooled application of their unusually esoteric knowledge and complex skill. In contrast, representatives of the other social sciences have stressed quite different characteristics of the professions. Economists have been inclined to note the closed, monopolistic character of the professionalized labor market (Cairnes, 1887, pp. 66–7; Friedman, 1962, pp. 137–60). Political scientists have been inclined to concern about professions as privileged private governments (Gilb, 1966). And policy-makers have been inclined to see professional experts as overnarrow and insular in their vision of what is good for the public (Laski, 1931).

The 1960s marked a watershed in sociological writings on the professions. For one thing, the evaluative flavour of the literature has changed. Whereas most sociologists had earlier emphasized the positive functions and achievements of the professions (though they were not unaware of their deficiencies), recent writers have been consistently more critical. Furthermore, the substantive preoccupation of the literature changed. In the earlier literature, the major scholarly writers focused primarily on the analysis of professional norms and role relations and on interaction in work settings. While they all acknowledged the importance of political and economic factors, they did not analyze them at any length. The more recent scholarly literature, on the other hand, focuses on the political influence of professions (Freidson, 1988), on the relation of professions to political and economic elites and the state (Johnson, 1972), and on the relation of professions to the market and the class system (Larson, 1977).

But while there have been significant changes in the evaluative and substantive emphasis of sociological writings on the professions, they reflect changes in the content of theorizing while remaining unchanged in the nature of theorizing. This has been the case even though some of the recent criticism of the traditional approach has been metatheoretical in character. Unfortunately, those metatheoretical critiques have addressed either false issues or issues which are essentially insoluble because of the very nature of the concept of profession itself. For this reason, there has not been any significant advance in developing a theory of professions over the past decade or so that does not have as many deficiencies as past theories.

This is the point of the present paper. In it, I shall examine several common metatheoretical issues addressed by recent writings on the professions, and evaluate both their validity and their utility for advancing a theory of professions. In doing so, it will be necessary to address the concept of profession itself. The very nature of that concept, I shall argue, plays a critical role in creating some of the problems addressed by metatheoretical writings and precludes their solution in abstract, theoretical terms. The nature of the concept of profession, I shall argue, provides us with a limited number of options. The option that can lead to a coherent and systematic method of analysis is one that requires forsaking the attempt to treat profession as a generic concept and turning instead to formulating a generic conception of occupation within which we can locate analytically the particular occupations that have been labelled professions. To advance a theory of professions, however, requires a rather different option, which treats the concept as a historical construction in a limited number of societies, and studies its development, use, and consequences in those societies without attempting more than the most modest generalizations.

THE PROBLEM OF DEFINITION

Much debate, going back at least as far as Flexner (1915), has centered around how professions should be defined – which occupations should be called professions, and by what institutional criteria. But while most definitions overlap in the elements, traits, or attributes they include, a number of tallies have demonstrated a persistent lack of consensus about which traits are to be emphasized in theorizing (Millerson, 1964, p. 5). No small part of the criticism of the traditional literature on the professions has been devoted to pointing out a lack of consensus. Because we seem to be no nearer consensus than we were in 1915, and because usage varies substantively, logically, and conceptually (Freidson, 1977), some analysts have given the impression of condemning the very practice of seeking a definition. But surely such condemnation is inappropriate. In order to think clearly and systematically about anything, one must delimit the subject-matter to be addressed by empirical and intellectual analysis. We cannot develop theory if we are not certain what we are talking about.

One method of attempting to solve the problem of definition has been to deprecate the value of defining the characteristics of professions as “inherently distinct from other occupations” (Klegon, 1978, p. 268) and to urge instead discussing the process by which occupations claim or gain professional status. The outcome of such a position, however, is to avoid entirely any conscious definition while in fact covertly advancing an implicit and unsatisfactorily vague definition of a profession as an occupation that has gained professional status. What is professional status? How does one determine when it does and when it does not exist? What are its characteristics?

A closely related suggestion is to shift focus from a “static” conception of profession as a distinct type of occupation to the process by which occupations are professionalized (Vollmer and Mills, 1966). However, as Turner and Hodge (1970, p. 23) and Johnson (1972, p. 31) have correctly noted, an emphasis on process rather than structure, on professionalization rather than on the attributes of professions, does not really solve the problem of definition. To speak about the process of professionalization requires one to define the direction of the process, and the end-state of professionalism toward which an occupation may be moving. Without some definition of profession the concept of professionalization is virtually meaningless, as is the intention to study process rather than structure. One cannot study process without a definition guiding one’s focus any more fruitfully than one can study structure without a definition.

In all, the issue of definition for a theory of professions cannot be dealt with profitably either by denial or by avoidance. A word with so many connotations and denotations cannot be employed in precise discourse without definition. One can avoid the issue of definition only if one adopts the patently anti-analytical position that all occupations – whether casual day-labor, assembly-line work, teaching, surgery, or systems analysis – are so much alike that there is no point in making distinctions of any kind among them. That there are no differences of any analytic importance must be firmly denied.

Given the necessity of definition, one may note that the character of an adequate definition must be such as to specify a set of referents by which the phenomenon may be discriminated in the empirical world – that is, specifying attributes, traits, or defining characteristics. Unfortunately, there has been a tendency in the recent critical literature to confuse the act of specifying defining characteristics with the particular characteristics specified by earlier writers. One can criticize a definition because of the analytically and empirically ambiguous traits it singles out (Freidson, 1988), or because its traits have no systematic interrelations and no theoretical rationale (Johnson, 1972). But it is not the fact that a definition is composed of traits or attributes that can be justifiably criticized.

In all, then, it would seem that, in the present state of the art of theorizing about professions, recent comments on the issue of definition miss the mark. The definitional problem that has plagued the field for over half a century is not one created by squabbling pedants, to be solved by eschewing definition entirely. Nor is the problem created by the adoption of a static “structural” or “functional” approach, to be solved by a “process” or “conflict” approach. Nor is the problem created by including traits or attributes in a definition. The problem, I suggest, lies much deeper than that. It is created by attempting to treat profession as if it were a generic rather than a changing historic concept, with particular roots in an industrial nation strongly influenced by Anglo-American institutions.

THE PAROCHIALISM OF THE INSTITUTIONAL CONCEPT OF PROFESSION

In order to elaborate my argument about the nature of the concept of profession, it is necessary first of all to emphasize the difference between two very different usages which are sometimes confused. First, there is the concept of profession that refers to a broad stratum of relatively prestigious but quite varied occupations whose members have all had some kind of higher education and who are identified more by their educational status than by their specific occupational skills. Second, there is the concept of profession as a limited number of occupations which have particular institutional and ideological traits more or less in common. It is only this second concept which allows us to think of “professionalism” as, in Johnson’s terms, a way of organizing an occupation (Johnson, 1972, p. 45). It represents much more than only a status, for it produces distinctive occupational identities and exclusionary market shelters (cf. Parkin, 1979) which set each occupation apart from (and often in opposition to) the others.

Furthermore, the two differ markedly in their relevance to present-day industrial societies. The concept of profession as a very broad, educated stratum has been applied without much difficulty to all industrial nations (for example, Ben-David, 1977, p. 30). But it refers to a much more general and vague phenomenon than does the institutional concept of profession as a distinctive form of organized occupation. The major theoretical writings on the professions have all addressed themselves to professions in this second sense – as a fairly limited number of occupations which share characteristics of considerably greater specificity than higher education alone, and which are distinctive as separate occupations. Their members conceive of themselves by their occupation first and by their “class,” if at all, only second. It is precisely this institutional concept of profession which is very difficult to apply to the entire range of occupations in the “professional stratum” of any industrial nation, or even to those middle-class occupations in Europe which would, in Anglo-American nations, be considered professions in the more narrow sense.

Occupations called professions in English have had a rather special history. As we all know, the medieval universities of Europe spawned the three original learned professions of medicine, law, and the clergy (of which university teaching was part). Elliott (1972, pp. 14, 32) has suggested the term “status professions” for them, pointing out quite accurately their marked difference from the recent “occupational professions.”

As the occupational structure of capitalist industrialism developed during the nineteenth century in England, and then later in the United States, terminological consensus became greatly confused by the efforts of newly reorganized or newly formed middle-class occupations to seek the title of “profession” because it was connected with the gentlemanly status of the traditional learned professions (Reader, 1967; Larson, 1977). While there were very important differences between the two nations, they had in common a comparatively passive state apparatus with a strong but by no means unambivalent laissez-faire philosophy, and a small civil service.

Occupations seeking a secure and privileged place in the economy of those countries could not do more than seek state support for an exclusionary shelter in the open market where they had to compete with rival occupations. They had to organize their own training and credentialling institutions, since the state played a passive role in such affairs. Unlike in other countries, the title “profession” was used to establish the status of successful occupations; it became part of the official occupational classification scheme in the United States and in England, expanding its coverage slowly by including more occupations in the same category, with the same title, as the original status professions of the medieval universities (see Reader, 1967, pp. 146–66, 207–11). Gaining recognition as a “profession” was important to occupations not only because it was associated with traditional gentry status, but also because its traditional connotations of disinterested dedication and learning legitimated the effort to gain protection from competition in the labor market. Given laissez-faire philosophy, only quite special excuses could justify the state-sanctioned creation of a market shelter. The ideologies of special expertise and moral probity provided by the traditional concept of status profession, sustained by ostensibly supportive occupational institutions, provided just such a basis for legitimating protection from the winds of occupational competition.

In England and the United States, the tendency was for each occupation to have to mount its own movement for recognition and protection. Its members’ loyalties and identities were attached to their individual occupation and its institutions. The situation was rather different in Europe, where the state was much more active in organizing both training and employment. The traditional status professions maintained their occupational distinctions as they reorganized their corporate bodies, but the new, middle-class occupations did not seek classification as “professions” to gain status and justify a market shelter: such an umbrella title imputing special institutional characteristics to them is not employed to distinguish them (see Hughes, 1971, pp. 387–8). Rather, their status and security are gained by their attendance at state-controlled, elite institutions of higher education which assures them of elite positions in the civil service or other technical-managerial positions. In nineteenth-century Russia and Poland, merely to be a graduate of a gymnasium was what was important, not one’s occupation (Gella, 1976). In Germany, what was important was to be a university graduate, an Akademiker (Rueschemeyer, 1973, pp. 63–122; Ringer, 1979, p. 411). In France, one’s fortunes flowed from attending one of the grandes écoles (Ben-David, 1977, pp. 38–46). Primary identity was not given by occupation, but by the status gained by elite education no matter what the particular specialty. As Ben-David noted for France,

the technically competent … whom the [grandes écoles] system was … designed to produce … do not primarily identify themselves by their professional qualifications, but by their employment. If they are in private practice, they tend to consider themselves part of the bourgeois entrepreneur class, and if they are salaried, they consider themselves officials of a certain rank, rather than chemists or engineers. (1977, p. 46)

This is a far cry from Anglo-American professions, which gain their distinction and position in the market-place less from the prestige of the institutions in which they were educated than from their training and identity as particular, corporately organized occupations to which specialized knowledge, ethicality, and importance to society are imputed, and for which privilege is claimed.2

It is thus not without justice that professionalism has been called “the British disease” (Fores and Glover, 1978, p. 15), though I would prefer to call it an “Anglo-American disease.” Nor is it an accident that the theoretical literature on the professions is almost wholly Anglo-American, European reviews and use of the Anglo-American literature notwithstanding (Maurice, 1972, pp. 213–25). All in all, I would argue that, as an institutional concept, the term “profession” is intrinsically bound up with a particular period of history and with only a limited number of nations in that period of history.

THE INEVITABILITY OF APOLOGETICS AND POLEMICS

If we grant the concrete, historically bound character of the term, we can better understand some of the other controversies surrounding definition in the recent literature. Metatheoretical critiques have frequently noted that earlier writings on the professions created definitions which were reflections of what spokesmen for Anglo-American occupations seeking social recognition as professions say about themselves (Freidson, 1988, pp. 77–84; Gyarmati, 1975, pp. 629–54). Roth (1974, p. 17) put this criticism very forcefully: “Sociologists … have become the dupe of established professions (helping them justify their dominant position and its payoff) and arbiters of occupations on the make.” The implication of such criticism is that theorizers should in some sense strive to create a definition which does not reflect the interests of the groups it attempts to delineate, that their definition should be more detached in its perspective. However, because of the very nature of the concept, one cannot avoid its intrinsic connection with the evaluative social processes which create it.

For the professions, the issues for commentary and analysis are determined more or less by the national history of the term itself, and by the usage of that term both by members of particular occupations and by members of other groups in Anglo-American society. Given the historical fact that the term is a socially valued label, with the possibility of social, economic, political, or at the very least symbolic rewards accruing to those so labelled, it seems inevitable both that disagreement about its application to particular persons or occupations will exist, and that disagreement will exist about the propriety of the special rewards accruing to those to whom it is applied. Because of the nature of the concept, any enterprise of defining and analysing it is inevitably subject to the possibility of being employed to direct the assignment and justification of rewards to some, and the withholding of rewards from others.

It follows, therefore, that those whom Roth described as “dupes” sustain the positions both of established professions and those attempting to gain their success by emulating them. It also follows, however, that those, including myself and Roth, who undertake highly critical evaluations of others’ definitions and analyses, also serve as “dupes,” though of different agents – “dupes” both of managerial programs of deskilling and proletarianizing professional work, and of working-class movements aimed at reducing pay differentials and barriers to entry into “professional” jobs. Both sets of writers, while differing in substance, do not differ in intellectual approach to the concept. The watershed of the scholarly literature that I noted as occurring in the 1960s was a watershed in changing social sympathy and substantive interest, but marked no break with the earlier preoccupation of adjudicating the application of the label and its rewards. Perhaps that is why there have not been any coherent advances in theorizing in spite of the marked change in the tone of the literature – because the basis for theorizing has not changed.

THE PHENOMENOLOGY OF PROFESSION

A “profession” may be described as a folk concept, then the research strategy appropriate to it is phenomenological in character. One does not attempt to determine what profession is in an absolute sense so much as how people in a society determine who is a professional and who is not, how they “make” or “accomplish” professions by their activities, and what the consequences are for the way in which they see themselves and perform their work. This is not, however, a simple undertaking, for we cannot realistically assume that there is a holistic folk which produces only one folk concept of profession in societies as complex as ours. There must be a number of folk and thus a number of folk concepts. Surely it seems likely that rather different concepts of profession would be advanced by occupations seeking the rewards of a professional label than by other occupations attempting to preserve the rewards they have already won, or by sets of employers or clients seeking to control the terms, conditions, and content of the jobs they wish done, or by government agencies seeking to create a systematic means by which to classify and account for the occupations of the labor force, or by the general public. Indeed, the very fact of such a variety of group interests and perspectives may be seen to be responsible for the variety of conceptions of profession advanced, each to its own appreciative audience, responsible for the dissensus characteristic of the usage and concrete occupational referents of the term. Is there, however, one of those perspectives which can be said to be authoritative? Are there others which can be said to be invalid or unimportant?

Many recent critics of the literature on professions seem to feel that it is somehow inappropriate for sociologists to make their own pronouncements about the essence of the concept of profession, and thus to serve as arbiters or dupes. Some urge that sociologists should instead study how other members of society employ the concept without projecting their own conceptions. In a well-reasoned statement, Dingwall (1976, pp. 331–49) suggested that, rather than define professions by fiat, sociologists would do better to devote themselves to the study and explication of the way ordinary members of particular occupations invoke and employ the term during the course of their everyday activities, to study how such members “accomplish” profession independently of sociologists’ definitions. However, unlike most critics, who are content with exhortation alone, Dingwall goes on to present data from an interesting study of his own which took that advice seriously. But my reading of his study indicates that such accomplishment on the part of the members of one occupation cannot fail to include taking into account the conceptions of members of other occupations with whom interaction takes place, and negotiating with them some workable agreement on usage and the activities and relationships it implies. Nonetheless, even that is not enough: among the groups which have to be taken into account are the very sociologists who define profession by fiat, since they, too, are members of the phenomenological world of occupations.

Sociologists are part of social life, and they produce some of the symbolic resources employed by other members of their society, most especially when they play the deliberately accessible role of commenting on and analysing contemporary social issues. In their way, serving in their special role of intellectual, sociologists accomplish profession as much as do the occupations they discuss. Even without efforts at disseminating their analyses widely by popularization, the esoteric, specialized work of sociologists is sought out by others and, if not taken as authoritative, then at least considered worth thinking about. Perhaps most consequentially for the actual process of professionalization, some sociological formations are employed in part as rationale and justification for the creation of the official occupational categories by which modern governmental and corporate agencies sort and classify occupations with an eye to justifying job requirements, perquisites, and wage differentials (Scoville, 1965; Désrosières, n.d.; Davies, 1980). Those official categories, or titles, and the criteria by which they are constituted, pose critical contingencies for the rewards available to an occupation, including the status of “profession.”

If they are to succeed in their attempt to gain the official title of profession, it is not enough that occupations accomplish profession inter-personally, negotiating their daily tasks with the others with whom they work. Both the limits and the substance of negotiation are in part given in advance. Only after getting jobs of a given character can the members of an occupation negotiate profession with other workers. In order to obtain the jobs which provide the resources for negotiation, both the institutional characteristics of an occupation and such characteristics of its members as their formal education must conform to official criteria of profession. Cosmetic changes on the institutional face which an occupation presents to the world may not be enough for official recognition. The everyday world of the ordinary members of a striving occupation may also have to change, taking on some of the appearances that sociologists have specified as intrinsically professional, albeit by fiat (Hughes, 1971, p. 339). Thus, how everyday members accomplish profession through their activities may be in part influenced by how sociologists accomplish profession as a concept, and by how official agencies accomplish profession as an administrative category.

What profession is phenomenologically, then, is not determined solely by members of occupations performing work in a way that leads others to respond to them as professionals. There are a number of different perspectives and performances, no one of which may be thought to be better grounded, phenomenologically, than any other. Some, however, are more consequential than others, if only because they are attached to positions in which it is possible to exercise substantial political and economic power of far-ranging significance. While these may not be authoritative in any epistemological sense, they might be taken to be authoritative in a pragmatic sense of setting the political and economic limits within which everyday professional work can go on, and of providing the political and economic resources without which some circumstances and opportunities for work cannot take place.3 Though such pragmatically authoritative “definitions” are themselves negotiated and changed by the efforts of organized occupational groups and other agencies, and thus are not so rigid and stable as the terms “official” and “formal” imply, they cannot be dismissed as somehow less legitimate than those of the participants in everyday work.

So, too, may the work of sociologists be viewed. As researchers and consultants in everyday work-settings, and as researchers and theorists whose work is examined and consulted by those formulating the legal and economic parameters of the market-place, sociologists also are legitimate participants. They can no more avoid creating definitions, if only implicitly, than can other participants. The fact of advancing definitions cannot be much of an issue in comparison with the choice of particular interests to advance in the social process of definition. But even there, the diversity of emphases and interests in the sociological literature implies a variety of choices. It also implies that the prospects for unanimity in the future are rather poor. How, then, can the state of the art be advanced?

BEYOND THE FOLK CONCEPT

One way of attempting to resolve the problem of defining and theorizing coherently about professions in institutional terms lies in asserting the role of the sociologist as an especially authoritative analyst who is free to forsake ordinary usage in favour of his own more precise and “scientific” abstractions. Even though sociologists in such a role cannot claim to be independent of their time and place, they can nonetheless attempt to create abstract concepts which are applicable to more than what is to be found in their time and place. Such an attempt has in fact been made by some of the more theoretically inclined writers on the professions. Remaining concerned with analyzing historic professions, they have abandoned the effort to delineate all the traits that professions have in common and attempted instead to emphasize a parsimonious set of circumstances which have analytic importance in themselves and with which other institutional characteristics can be connected systematically (Goode, 1969, pp. 266–313; Freidson, 1988, pp. 71–84; Johnson, 1972, pp. 37–47).

Interesting as those efforts may be, however, they have been too compromised to be successful. They are, as Becker (1970, p. 91) noted, no longer faithful to the folk concept insofar as they abstract and select from it. But at the same time they have stopped short of creating fully abstract concepts which go beyond the folk concept. If those efforts were to be really abstract and “scientific,” then their conceptualization would have to be tested by examining all occupations known to have the postulated critical traits of trust, autonomy, collegial control, or whatever, but instead, only the occupations called professions are referred to by such writers. Were they to go beyond the folk concept, no longer would they be addressing professions as such so much as occupations in general. That is the crux of the matter.

I do not believe that it is possible to move beyond the folk concept of profession without forsaking one’s preoccupation with professions (Turner and Hodge, 1970, p. 33). In order really to move beyond the folk concept one must ask on the grounds of some reasoned theoretical stance what the features are by which one may usefully and consequentially distinguish among occupations in general and the processes through which they develop, maintain themselves, grow, and decline. On the basis of such features one could distinguish theoretically significant groupings or types of occupations and occupational processes by which historically defined occupations, including professions, could be classified and understood. Since theoretical salience is the issue, and not the historic Anglo-American professions as such, no attempt would be made to create a class into which would fit all the occupations that are called professions. By the nature of the enterprise, no attempt need